HomeMy WebLinkAbout0221 1C~ T11E ;,lAlt: Ah[) CUIItJIY 1/~X !?'..'-,f ~`:Of~. ' ' ~ 302
;1. LUCIE CQUNIY, FIOhIUl~:
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This is my declaralion of Oomicil~~ and Citizcnship in tho Stale of Florida that 1 am iiling this day in accordance and
in conformily with Chapte~ 22?, Section 222.17, Florida Statutes. . ~ .
I was formerly a Icgal resident of o~~
• (City) • (State)
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end 1 resided at ~~'/~'''J ~ . However 1 have changed my domitile
. • ' (Sfteet and Numbe~) ~ • ~
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Io and am and have been a, bona fide resident of the State of florida since . l 7~ day of
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, 19~, and 1 ~eside at l~"~
• - ~v~ . ~f _ • (St~eet a Number)
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fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fb~ida.
• -(Inse~t here any peninent facts, such as sale of property or business, or ~elinquishment of employment
et fo~mer domicile, removal of family to new domicile, purchase of home, .etcJ , . ~
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- - . ~Applyingi for Homestead ~ . ~ ' .
. Entering children in school : - - - - ~
- • - • . ' - - - : . _ iT~~CiE GOVlITX~U. " . ~ . : -
_ • . ROC~a ~Q~TRt~6 ' ~ ~
• . ' - . C1.E~lK CiRC01T COU11T•. .
. - ' _ ~ • . - . • . REC4RD'VER~FIED~~ . •
- - ~ - ~ . . • . - N~r_ i~l ~ 10 ~i9 ~'l'~3 - - - -
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- _ _ - . . . _ - _ : • ~254302 - ~ _ _ .
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1 FURTHER CERTIFY that I will comply with all ofher requirements of a legal ~esident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domitile, and 1 intend fo remain in FORT
r{tKCE, SAINT IUCIE COUNTY, FLORIDA, permanently. ' ,
' • l/~ , d~
~ . ' . (Name) .
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=1 (Address)
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~ ~ ~o?~r ~q ~~:s~biscc~.bed before me this day of , 19~ ' ;
, .•"~~tiili, Cr_ _ 't • , ~
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~'.~R~' - ~C~~COURt Notary Public
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Qy ~ ~.C. My Commission cxpires
~ ~ BooK 214 PacE ?21
(To bo oxoculed-in duplicalo and ~.~:•~~nal fikd wilh C~k Circuil Courl, and duplicato with Tax Assoswr.) ,
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